'Times' Health Care Op-Ed Gets Unexpected Response

Robert Siegel talks to New York Times columnist Nick Kristof about his friend and college roommate Scott Androes, who was diagnosed with Stage Four prostate cancer. In two recent columns, Kristof wrote about Androes, who didn't have health insurance at the time of the diagnosis. In Thursday's paper, Kristof writes that Androes drifted into a coma Sunday and died Monday morning.

In Sunday's New York Times, columnist Nicholas Kristof wrote about his friend, Scott Androes, his freshman year roommate in college. They were both Oregon farm boys at Harvard. Thirty years later, Scott had stage four prostate cancer and was paying a steep cost for a midlife crisis in which he'd been highly irresponsible. He'd quit his job, worked seasonally as a tax preparer, read books, played poker and, to make ends meet, let his health insurance lapse. Then came the cancer diagnosis.

In today's paper, Nick Kristof writes that Scott drifted into a coma Sunday and died Monday morning. And Kristof writes about what readers had to say about his first column. Nicholas Kristof joins us now. Welcome to the program.

NICHOLAS KRISTOF: Good to be with you.

SIEGEL: And first, just to get this off the table, this is a story of a man who, your words, screwed up.

KRISTOF: Yeah. And that was something that he fully acknowledged, that he kept saying to me: I blew it.

SIEGEL: And you figure that his health insurance having lapsed, the care that he received and his condition were worse for his not having health insurance.

KRISTOF: That's right. Scott wasn't getting physicals. And when he first began to have difficulty urinating a year ago, he did not go see a doctor and part of that was the cost. He eventually did go to a strip mall clinic but by the time the condition was diagnosed, it had spread to his bones and it was too late to address.

SIEGEL: Now, the point of your first column was to publicize, as your friend Scott hoped his story would, the need for universal health insurance. But today you write that some readers read the story, read the column, and that was in their reaction at all.

KRISTOF: No, there are a lot of people who were sympathetic. But there were also a number who were really kind of extravagantly, flamboyantly, savagely unsympathetic and who said essentially, look, he made a mistake and mistakes have consequences.

SIEGEL: The mistake here being he gave up his health insurance.

KRISTOF: That's correct. That he could have afforded health insurance and why should it be my job to worry about him? That was the reaction of a certain number of people.

SIEGEL: This raises a question about health insurance and many other programs to which we all ante up and then benefit from, if need be. And that is, what do we make of somebody who screws up? What do we make of somebody who makes a mistake and was smart enough to have done otherwise but didn't?

KRISTOF: I mean it just seems to me that we all make mistakes. To err is central part of the human condition. You know, a 911 operator, if there's been a car crash, doesn't inquire whether somebody was speeding before dispatching an ambulance. We compensate for the human capacity to make errors. That's why we have guard rails on highways. It's why we require seatbelts. And the notion that somebody like Scott, because he made a mistake, should therefore die just seems extraordinarily harsh to me.

SIEGEL: Well, take us back as best you can hypothetically to the point when Scott Androes was changing his life and getting out of the pension consulting business and deciding to live by his wits. If there'd been a law saying you must have health insurance and you must pay for it, would he have done so?

KRISTOF: He was very clear that he would have. And in particular, he noted that health insurance would then have been more affordable. One of the problems right now is that when you try to buy an individual policy on the individual market, then you tend to be in a high-risk pool in that individual policy is very expensive.

In the system that is going to come in place in 2014, under Obamacare, it will presumably become substantially more affordable because of risk pooling. And Scott insists that he would have gotten insurance in that case and in that case would, indeed, have checked out his symptoms much, much earlier in the process.

SIEGEL: One of your readers who just describe him Bruce in today's column, writes to you in part: smoking, obesity, drugs, alcohol, noncompliance with medical advice, extreme age and debility; patient so sick, old, demented, weak that if families had to pay one-tenth the cost of keeping the poor souls alive, they would instantly see that it was money wasted. Right?

KRISTOF: Yeah, there is kind of a Hobbesian approach that so many people seem to have to this. And yes, there are some people who make mistakes and people who don't keep track of their health as much as they should. But one of the points of living in a sensitive community is to have some empathy and compassion for other human beings. And to me, compassion is not a sign of weakness, it's a sign of civilization.

SIEGEL: The question arises, say, in the issue of the liver transplant. Does the patient who has drunk his liver to the point of dysfunction, is that person an equal candidate for a transplant as somebody who just happens to have, for some other reason, contracted some terrible liver ailment?

KRISTOF: Well, I mean if you're trying to allocate resources most efficiently, then there may be reasons to penalize somebody who hasn't been as cautious as they should have. But I do think that is a different question from the one of should we try to provide universal health care. And there, I think, it's not only a moral imperative but also, frankly, an economic imperative.

I mean, all these people who are writing in to me that, you know, they don't want to - why should they pay Scott's bills? Well, you know, they did. Scott accumulated more than $550,000 in bills at Swedish Medical Center in Seattle. And that was because he didn't have insurance, didn't have cancer screening, because this wasn't detected early. And who is going to pay that? I mean, it's you and me and all of us.

SIEGEL: So, in effect, Scott is saying if I had been required to contribute toward my own care - although probably for years before that he had contributed to health insurance premiums that mounted...

KRISTOF: That's correct.

SIEGEL: ...to the benefit of some insurance company - then that would have defrayed the expense for the rest of us in terms of...

KRISTOF: That's right. And, look, we do know that statistically as a nation, there would be many cancers, many other conditions that would be caught and many lives saved. And this imperative to kind of point fingers and say, ah, but you've screwed up, you don't deserve the same kind of care that I do; you don't deserve to be in the same risk pool as me, that strikes me as really profoundly almost sociopathic and offensive.

And I think it also ignores just the economic gains to all of us if we can have people get preventive treatment and not only save their lives, but save money along the way.

SIEGEL: You would say we're all in this boat together and we all, at some point or another, screw up in some way or another.

KRISTOF: Yeah. And, you know, trying to carve boats in half so that other people aren't in your boat is not a good idea for anybody, nautically speaking.

SIEGEL: Well, Nicholas Kristof of The New York Times, thanks a lot for talking with us.

KRISTOF: My pleasure.

SIEGEL: Nicholas Kristof's columns today and this past Sunday are about his friend, Scott Androes, who gave up his health insurance and was later diagnosed with prostate cancer. Androes died on Monday.

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